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[Preoperative noninvasive tests for localization of enlarged parathyroid glands in 115 patients with
E van der Harst1, H J Bonjer, H A Pols
1Afd. Algemene Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Objective:
To evaluate results of preoperative localisation techniques in patients operated for hyperparathyroidism (HPT).
Setting:
Rotterdam University Hospital.
Design:
Retrospective study.
Method:
Results of 4 non-invasive preoperative localisation techniques in 115 patients with HPT were compared with operative findings of 116 explorations. Sensitivity and specificity were calculated for single versus multiple gland disease, primary exploration versus re-explorations and anatomical versus ectopic localisation.
Results:
Sensitivity of preoperative ultrasound, thallium-technetium subtraction scintigraphy, computed tomography and 99mTc-sestamibi (MIBI) scanning in patients with single gland disease was 56%, 65%, 67% and 83% respectively. In multiple gland disease preoperative localisation techniques were much less successful. For MIBI scintiscanning this question remains unanswered. Specificity of all techniques was high. Success rates of preoperative localisation studies for primary operations and re-explorations were similar. Mean weight of parathyroid tumours that were missed preoperatively was lower than of successfully localised tumours. Only computed tomography and thallium-technetium scintigraphy were able to localise retrosternal parathyroid tumours.
Conclusion:
Review of the literature reveals that there is additional benefit of the preoperative localisation studies in re-exploration for HPT, in contrast to primary exploration. By combining localisation techniques more tumours are visualised. Preliminary results of MIBI scanning are favourable.